Table 3 Views on hormonal contraceptives and side effects by respondent group

Postpartum women

Women are concerned/confused about how hormonal contraceptives function

● Visit health center to speak with provider

Women link side effects to other illnesses/conditions (e.g., impaired child development, sterility)

● Abstain from, switch or discontinue hormonal contraceptive use

Partners of postpartum women

Husbands/partners primarily concerned about wife/partner experiencing side effects (e.g., losing excessive blood, feeling ill and/or becoming infertile) or passing illness to breastfeeding children.

● Encourage woman to discontinue or change contraceptive method

● Use condoms to avoid side effects

● Abstain while partner is breastfeeding

Community members including CHWs, religious and political leaders

Religious authorities pressure families to avoid FP as it “kills God’s eggs” and could extend the duration of menses thereby inhibiting religious participation

● Encourage families to avoid all FP methods—especially hormonal contraceptives

Community impressions that FP side effects foster laziness and may induce infertility

● Encourage women to discontinue use to avoid fatigue/laziness and infertility

Health care providers

Providers describe challenges to counseling on FP and side effects especially time constraints. Providers have an impression that women are disinterested in counseling and “only want to get the method and go”

● Encourage women to continue with method if side effects are not severe

Providers perceive the distribution of contraception to be more important than discussion of side effects

● Encourage alternative methods in instance of severe side effects (and provide these methods)

Providers weigh the benefit of secrecy (associated with injectables) over the drawback of side effects among patients whose husbands oppose contraceptive use

● Allow women to choose their preferred contraceptive method, notwithstanding potential side effects